Independent association of history of diabetic foot with all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study
Abstract Background Foot ulcers and/or infections are common long-term complications of diabetes and are associated with increased mortality, especially from cardiovascular disease, though only a few studies have investigated the independent contribution of these events to risk of death. This study...
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Cardiovascular Diabetology |
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| Online Access: | https://doi.org/10.1186/s12933-023-02107-9 |
| _version_ | 1827382387117391872 |
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| author | Martina Vitale Emanuela Orsi Anna Solini Monia Garofolo Veronica Resi Enzo Bonora Cecilia Fondelli Roberto Trevisan Monica Vedovato Giuseppe Penno Giuseppe Pugliese |
| author_facet | Martina Vitale Emanuela Orsi Anna Solini Monia Garofolo Veronica Resi Enzo Bonora Cecilia Fondelli Roberto Trevisan Monica Vedovato Giuseppe Penno Giuseppe Pugliese |
| author_sort | Martina Vitale |
| collection | DOAJ |
| description | Abstract Background Foot ulcers and/or infections are common long-term complications of diabetes and are associated with increased mortality, especially from cardiovascular disease, though only a few studies have investigated the independent contribution of these events to risk of death. This study aimed at assessing the association of history of diabetic foot with all-cause mortality in individuals with type 2 diabetes, independent of cardiovascular risk factors, other complications, and comorbidities. Methods This prospective cohort study enrolled 15,773 Caucasian patients in 19 Italian centers in the years 2006–2008. Prior lower extremity, coronary, and cerebrovascular events and major comorbidities were ascertained by medical records, diabetic retinopathy by fundoscopy, diabetic kidney disease by albuminuria and estimated glomerular filtration rate, cardiovascular risk factors by standard methods. All-cause mortality was retrieved for 15,656 patients on 31 October 2015. Results At baseline, 892 patients (5.7%) had a history of diabetic foot, including ulcer/gangrene and/or amputation (n = 565; 3.58%), with (n = 126; 0.80%) or without (n = 439; 2.78%) lower limb revascularization, and revascularization alone (n = 330; 2.09%). History of diabetic foot was associated with all-cause death over a 7.42-year follow-up (adjusted hazard ratio, 1.502 [95% confidence interval, 1.346–1.676], p < 0.0001), independent of confounders, among which age, male sex, smoking, hemoglobin A1c, current treatments, other complications, comorbidities and, inversely, physical activity level and total and HDL cholesterol were correlated independently with mortality. Both ulcer/gangrene and amputation alone were independently associated with death, with a higher strength of association for amputation than for ulcer/gangrene (1.874 [1.144–3.070], p = 0.013 vs. 1.567 [1.353–1.814], p < 0.0001). Both ulcer/gangrene/amputation and lower limb revascularization alone were independently associated with death; mortality risk was much higher for ulcer/gangrene/amputation than for revascularization (1.641 [1.420–1.895], p < 0.0001 vs. 1.229 [1.024–1.475], p = 0.018) and further increased only slightly for combined ulcer/gangrene/amputation and revascularization (1.733 [1.368–2.196], p < 0.0001). Conclusions In patients with type 2 diabetes, an history of diabetic foot event, including ulcer/gangrene, amputation, and lower limb revascularization, was associated with a ~ 50% increased risk of subsequent death, independent of cardiovascular risk factors, other complications and severe comorbidities, which were also significantly associated with mortality. The association with mortality was greatest for amputation, whereas that for revascularization alone was relatively modest. Trial registration ClinicalTrials.gov, NCT00715481, retrospectively registered 15 July, 2008. |
| first_indexed | 2024-03-08T14:18:49Z |
| format | Article |
| id | doaj.art-13d8ff083d154dce96637ac2c1038816 |
| institution | Directory Open Access Journal |
| issn | 1475-2840 |
| language | English |
| last_indexed | 2024-03-08T14:18:49Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Cardiovascular Diabetology |
| spelling | doaj.art-13d8ff083d154dce96637ac2c10388162024-01-14T12:10:59ZengBMCCardiovascular Diabetology1475-28402024-01-0123111210.1186/s12933-023-02107-9Independent association of history of diabetic foot with all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter StudyMartina Vitale0Emanuela Orsi1Anna Solini2Monia Garofolo3Veronica Resi4Enzo Bonora5Cecilia Fondelli6Roberto Trevisan7Monica Vedovato8Giuseppe Penno9Giuseppe Pugliese10Department of Clinical and Molecular Medicine, “La Sapienza” UniversityDiabetes Unit, Fondazione IRCCS “Cà Granda - Ospedale Maggiore Policlinico”Department of Surgical, Medical, Molecular and Critical Area Pathology, University of PisaDepartment of Clinical and Experimental Medicine, University of PisaDiabetes Unit, Fondazione IRCCS “Cà Granda - Ospedale Maggiore Policlinico”Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of VeronaDiabetes Unit, University of SienaEndocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIIIDepartment of Clinical and Experimental Medicine, University of PaduaDepartment of Clinical and Experimental Medicine, University of PisaDepartment of Clinical and Molecular Medicine, “La Sapienza” UniversityAbstract Background Foot ulcers and/or infections are common long-term complications of diabetes and are associated with increased mortality, especially from cardiovascular disease, though only a few studies have investigated the independent contribution of these events to risk of death. This study aimed at assessing the association of history of diabetic foot with all-cause mortality in individuals with type 2 diabetes, independent of cardiovascular risk factors, other complications, and comorbidities. Methods This prospective cohort study enrolled 15,773 Caucasian patients in 19 Italian centers in the years 2006–2008. Prior lower extremity, coronary, and cerebrovascular events and major comorbidities were ascertained by medical records, diabetic retinopathy by fundoscopy, diabetic kidney disease by albuminuria and estimated glomerular filtration rate, cardiovascular risk factors by standard methods. All-cause mortality was retrieved for 15,656 patients on 31 October 2015. Results At baseline, 892 patients (5.7%) had a history of diabetic foot, including ulcer/gangrene and/or amputation (n = 565; 3.58%), with (n = 126; 0.80%) or without (n = 439; 2.78%) lower limb revascularization, and revascularization alone (n = 330; 2.09%). History of diabetic foot was associated with all-cause death over a 7.42-year follow-up (adjusted hazard ratio, 1.502 [95% confidence interval, 1.346–1.676], p < 0.0001), independent of confounders, among which age, male sex, smoking, hemoglobin A1c, current treatments, other complications, comorbidities and, inversely, physical activity level and total and HDL cholesterol were correlated independently with mortality. Both ulcer/gangrene and amputation alone were independently associated with death, with a higher strength of association for amputation than for ulcer/gangrene (1.874 [1.144–3.070], p = 0.013 vs. 1.567 [1.353–1.814], p < 0.0001). Both ulcer/gangrene/amputation and lower limb revascularization alone were independently associated with death; mortality risk was much higher for ulcer/gangrene/amputation than for revascularization (1.641 [1.420–1.895], p < 0.0001 vs. 1.229 [1.024–1.475], p = 0.018) and further increased only slightly for combined ulcer/gangrene/amputation and revascularization (1.733 [1.368–2.196], p < 0.0001). Conclusions In patients with type 2 diabetes, an history of diabetic foot event, including ulcer/gangrene, amputation, and lower limb revascularization, was associated with a ~ 50% increased risk of subsequent death, independent of cardiovascular risk factors, other complications and severe comorbidities, which were also significantly associated with mortality. The association with mortality was greatest for amputation, whereas that for revascularization alone was relatively modest. Trial registration ClinicalTrials.gov, NCT00715481, retrospectively registered 15 July, 2008.https://doi.org/10.1186/s12933-023-02107-9Type 2 diabetesAll-cause mortalityDiabetic footFoot ulcerAmputationLower limb revascularization |
| spellingShingle | Martina Vitale Emanuela Orsi Anna Solini Monia Garofolo Veronica Resi Enzo Bonora Cecilia Fondelli Roberto Trevisan Monica Vedovato Giuseppe Penno Giuseppe Pugliese Independent association of history of diabetic foot with all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study Cardiovascular Diabetology Type 2 diabetes All-cause mortality Diabetic foot Foot ulcer Amputation Lower limb revascularization |
| title | Independent association of history of diabetic foot with all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study |
| title_full | Independent association of history of diabetic foot with all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study |
| title_fullStr | Independent association of history of diabetic foot with all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study |
| title_full_unstemmed | Independent association of history of diabetic foot with all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study |
| title_short | Independent association of history of diabetic foot with all-cause mortality in patients with type 2 diabetes: the Renal Insufficiency And Cardiovascular Events (RIACE) Italian Multicenter Study |
| title_sort | independent association of history of diabetic foot with all cause mortality in patients with type 2 diabetes the renal insufficiency and cardiovascular events riace italian multicenter study |
| topic | Type 2 diabetes All-cause mortality Diabetic foot Foot ulcer Amputation Lower limb revascularization |
| url | https://doi.org/10.1186/s12933-023-02107-9 |
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